Many insurance companies will not automatically pay a claim with a 59. Because it's a thoroughly over used and abused modifier you will likely have to submit documentation to show why the service should be paid separately.

Only if you have a reason to use a modifier. You can't just slap one on to get it paid.

The Office of Inspector General (OIG) published a study in November 2005 detailing significant incorrect use of modifiers 25 (modifiers used when an E&M or other procedure or service, is billed in conjunction with another procedure). The OIG found that thirty-five percent of claims using modifier 25 allowed by Medicare in 2002 did not meet program requirements, resulting in $538 million in improper payments. Problems ranged from definite inappropriate usage, to insufficient documentation to determine if the use was appropriate, to needless use (e.g., an E&M with a modifier 25 in the absence of another procedure). CMS has accepted the OIG findings and will be urging carriers to heighten scrutiny of these modifiers. This study followed a California study performed in 2003 of a probe of 200 randomly-selected claims.

Obviously the 25 is incorrect. There is a reason this 76705 is inclusive. When performing Duplex scan, you see all of the retroperitoneal organs. Normally, there shouldn't be a need to perform an ultrasound as well.